2020 Vitual Portal   |   Past & Future Meetings
International Coronary Congress

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Fully endoscopic use of coronary stabilizer: proof of concept and initial experience
Luigi Ranieri, Stefano Borsellino, Christiaan Van Kerrebroeck, Herbert Guttermann, Matteo Pettinari
Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium

Objective Totally endoscopic coronary artery bypass grafting (TECAB) is an existing strategy for minimal invasive myocardial revascularisation. The robotic stabilizer however is no more available for the current robotic platforms. Alternative methods for coronary stabilization are therefore needed. We describe an approach to use the actual minimal invasive stabilizer fully endoscopically.
Methods After mammary artery harvesting with the Da Vinci Xi system, an incision of 2.5 cm at the fourth intercostal space or subxyfoidal is performed. Through the incision, we insert a single port laparoscopic surgery device (SILM Medtronic, or GelPOINT Applied Medical, Figure 1). The Octopus Nuvo is inserted via this port maintaining CO2 insufflation and pressure in the left chest and manipulated via the robotic arm to achieved target stabilization.
Results Five consecutive patients planned for a minimally invasive CABG were treated. Adequate stabilization of the left anterior descending was obtained. No procedural complications were reported. After stabilization, the procedure was completed via small thoracotomy with a direct vision to perform a hand-sewn anastomosis.
Conclusions We present an alternative method to using the actual coronary stabilizer fully endoscopically. This could allow TECAB to use other robotic platforms and permit the use of the fourth robotic arm for other purposes.


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